 "The heart of the matter")
With genetic susceptibility, Indians are known to be vulnerable to heart disease. Now, a study by SRL Diagnostics, conducted over three years, reveals that another factor is contributing to cardiovascular disease, particularly in men: higher-than-normal levels of homocysteine, an amino acid that occurs naturally in blood.
The study, conducted on about 50,000 people, found higher levels of homocysteine in men in the age group of 31 to 45. In women, high homocysteine levels were more commonly seen at 46 years of age and above.
The western part of India showed maximum cases of abnormal levels of homocysteine in both males and females. And, the least such cases in both men and women were found in north India.
"Hyperhomocysteinemia (high level of the amino acid) inflicts damage to the inner arterial lining," says Vishakh Varma, consultant, critical care, Aakash Healthcare, New Delhi. "This leads to inflammation and narrowing of the arteries." These narrow arteries are not able to supply adequate amount of blood to vital organs, leading to heart disease, stroke, decreased vision or hearing loss, Varma adds.
"This also predisposes the person for blockage in the artery," says Rajneesh Malhotra, director, cardiothoracic and vascular surgery, Max Super Speciality Hospital, Saket, New Delhi. Many studies have shown a strong correlation between increase in heart disease risk and high homocysteine levels, he adds.
The normal level of homocysteine, for both men and women, is between 4 and 15 micromoles per litre (µmol/L), with the optimal levels being below 10. Hyperhomocysteinemia, meanwhile, is classified as moderate (15 to 30 µmol/L), intermediate (30 to 100 µmol/L) and severe (more than 100 µmol/L).
The study found that in women, the problem of hyperhomocysteinemia is relatively less common. Across India, 73 per cent of women had homocysteine levels well within the normal range of 0 to 15 µmol/L.
High homocysteine levels are a result of a familial or genetic problem. People who have high homocysteine levels usually lack high levels of vitamin B, B12, B6 and folic acid. "Even low levels of thyroid hormones, kidney disease or some other condition that runs in the family can trigger high homocysteine levels," says Malhotra.
Anyone who is genetically predisposed for high homocysteine levels, suffers from these vitamin deficiencies, renal disease or has high cholesterol level should go for a homocysteine test - "at least once every six months," advises Malhotra. The test is easily available at almost all hospitals and laboratories and requires overnight fasting. It can cost about Rs 900.
It has been observed in various clinical studies that with each 5 µmol/L increase in the homocysteine level, the risk of coronary heart disease is amplified by about 20 per cent, states the SRL Diagnostics report. This is independent of the traditional coronary heart disease risk factors such as cholesterol, high blood pressure and smoking.
Malhotra says that because it is genetic, the problem cannot be prevented. However, it can be controlled to some extent by consuming supplements of the lacking vitamins in the body. "Eat more fruits and leafy, green vegetables. Avoid red meat and high consumption of alcohol," he says. Consume breakfast cereals, fortified grain products, lentils, asparagus, spinach and most beans that are good sources of folate (folic acid). Non-vegetarians should stick to fish, organic meat or white meat, he advises.
Varma adds that several dietary and lifestyle changes can help reduce homocysteine levels. "Avoid methionine-rich foods like red meat and dairy products. (Methionine is another amino acid.) Regular aerobic exercises are very effective. And , decrease or eliminate alcohol and smoking." Vitamins B6, B12 and folic acid in the prescribed doses are the treatment of choice for high homocysteine levels.
